Contributions
Abstract: EP1304
Type: ePoster
Abstract Category: Clinical aspects of MS - 3 Paediatric MS
Background: Cross-sectional studies show structural and functional visual pathway changes in youth with acquired demyelinating syndromes (ADS).
Objective: To assess longitudinal structural and functional visual pathway changes in pediatric MS and monophasic ADS (monoADS), and to determine the relationship of sex to such changes.
Methods: Standard visual assessments including optical coherence tomography (OCT) (Cirrus HD-OCT) and visual function metrics (best corrected high-contrast and low-contrast letter acuity, color vision, visual field, visual evoked potentials) were collected prospectively (2010-2017) in children with MS and monoADS at variable intervals after incident demyelination and after clinical episodes of optic neuritis (ON), if any. Data acquired within 90 days from ON were excluded. Changes in structural and functional metrics were assessed using joint mixed multivariate longitudinal modeling. Results are reported for p< 0.05. No correction for multiple comparisons was performed given the exploratory nature of the study.
Results: We included 42 youth with MS (30f, mean follow-up (f-u) (SD) 1.4y (1.3)), and 41 with monoADS (23f, f-u 1.0y (1.3)). 38% MS and 43% monoADS had no episodes of ON. The first year post incident demyelination showed thinning of ganglion cell-inner plexiform layer (GCIPL) in males with MS (-25.4 µm/y) and retinal nerve fiber layer (RNFL) in females with MS (MSf) (-11.2 µm/y) and with monoADS (-9.8 µm/y). Thereafter, MSf showed milder, progressive RNFL and GCIPL thinning (-1.8 µm/y and -2.1 µm/y). Greater RNFL and GCIPL thinning was seen with increasing ON episodes (avg. -5.5 and -5.3 µm/episode). MSf with no history of ON had progressive RNFL and GCIPL thinning in the first year post incident demyelination (RNFL -12.0 µm/y; GCIPL -9.7 µm/y) and afterwards (RNFL -1.7 µm/y). Analysis of functional metrics showed progressive worsening of color vision in MSf (-0.02%/y), which correlated with RNFL (R=0.6) and GCIPL (R=0.4) decreases over time. No significant longitudinal changes were detected in other functional metrics.
Conclusions: Longitudinal assessment suggests progressive thinning of RNFL and GCIPL in youth with MS, which correlate with changes in color vision, and are more pronounced in females and in the first year post incident demyelination. Our results, which are limited due to the small number of male participants, may point to sexual dimorphism in the mechanisms of visual pathway damage or repair in pediatric MS.
Disclosure: Study supported by: Ontario Institute for Regenerative Medicine (OIRM). The Multiple Sclerosis Scientific Research Foundation (MSSRF) and NMSS.
Dr. Longoni receives training and research support from the National Multiple Sclerosis Society. Dr. Brown has received payment for consulting services from NeuroRx Research and Biogen Idec. Dr. Banwell receives research funding from the Canadian Multiple Sclerosis Research Foundation, the National Multiple Sclerosis Society, and the Canadian Institutes of Health Research. She has served as a central MRI reviewer for a Novartis, and as a non-remunerated advisor on clinical trial design for Biogen IDEC, Sanofi, Genzyme, and Teva Neuroscience. Dr. J.K. Mah serves as a a site investigator for Biogen, Sanofi-Genzyme, and Novartis . Dr. Mabbott receives research funding from CIHR. Dr. Yeh receives funding from the Guthy Jackson Charitable Foundation, NMSS, CMSC, OIRM, SCN, CBMH Chase an Idea, SickKids Foundation, Rare Diseases Foundation, MS Scientific Foundation (Canada), McLaughlin Centre, Mario Battaglia Foundation. Juno, Scientific Advisory Board, Neurotoxicity. ACI, clinical relapse adjudication. Novartis, speaker´s honorarium. MOH IGSP reviewer. A. Oyefiade, S. Shams, A. Noguera, S.A. Grover, Dr. Wilbur, Dr. Wan, Dr. Costello, Dr. Reginald have nothing to disclose.
Abstract: EP1304
Type: ePoster
Abstract Category: Clinical aspects of MS - 3 Paediatric MS
Background: Cross-sectional studies show structural and functional visual pathway changes in youth with acquired demyelinating syndromes (ADS).
Objective: To assess longitudinal structural and functional visual pathway changes in pediatric MS and monophasic ADS (monoADS), and to determine the relationship of sex to such changes.
Methods: Standard visual assessments including optical coherence tomography (OCT) (Cirrus HD-OCT) and visual function metrics (best corrected high-contrast and low-contrast letter acuity, color vision, visual field, visual evoked potentials) were collected prospectively (2010-2017) in children with MS and monoADS at variable intervals after incident demyelination and after clinical episodes of optic neuritis (ON), if any. Data acquired within 90 days from ON were excluded. Changes in structural and functional metrics were assessed using joint mixed multivariate longitudinal modeling. Results are reported for p< 0.05. No correction for multiple comparisons was performed given the exploratory nature of the study.
Results: We included 42 youth with MS (30f, mean follow-up (f-u) (SD) 1.4y (1.3)), and 41 with monoADS (23f, f-u 1.0y (1.3)). 38% MS and 43% monoADS had no episodes of ON. The first year post incident demyelination showed thinning of ganglion cell-inner plexiform layer (GCIPL) in males with MS (-25.4 µm/y) and retinal nerve fiber layer (RNFL) in females with MS (MSf) (-11.2 µm/y) and with monoADS (-9.8 µm/y). Thereafter, MSf showed milder, progressive RNFL and GCIPL thinning (-1.8 µm/y and -2.1 µm/y). Greater RNFL and GCIPL thinning was seen with increasing ON episodes (avg. -5.5 and -5.3 µm/episode). MSf with no history of ON had progressive RNFL and GCIPL thinning in the first year post incident demyelination (RNFL -12.0 µm/y; GCIPL -9.7 µm/y) and afterwards (RNFL -1.7 µm/y). Analysis of functional metrics showed progressive worsening of color vision in MSf (-0.02%/y), which correlated with RNFL (R=0.6) and GCIPL (R=0.4) decreases over time. No significant longitudinal changes were detected in other functional metrics.
Conclusions: Longitudinal assessment suggests progressive thinning of RNFL and GCIPL in youth with MS, which correlate with changes in color vision, and are more pronounced in females and in the first year post incident demyelination. Our results, which are limited due to the small number of male participants, may point to sexual dimorphism in the mechanisms of visual pathway damage or repair in pediatric MS.
Disclosure: Study supported by: Ontario Institute for Regenerative Medicine (OIRM). The Multiple Sclerosis Scientific Research Foundation (MSSRF) and NMSS.
Dr. Longoni receives training and research support from the National Multiple Sclerosis Society. Dr. Brown has received payment for consulting services from NeuroRx Research and Biogen Idec. Dr. Banwell receives research funding from the Canadian Multiple Sclerosis Research Foundation, the National Multiple Sclerosis Society, and the Canadian Institutes of Health Research. She has served as a central MRI reviewer for a Novartis, and as a non-remunerated advisor on clinical trial design for Biogen IDEC, Sanofi, Genzyme, and Teva Neuroscience. Dr. J.K. Mah serves as a a site investigator for Biogen, Sanofi-Genzyme, and Novartis . Dr. Mabbott receives research funding from CIHR. Dr. Yeh receives funding from the Guthy Jackson Charitable Foundation, NMSS, CMSC, OIRM, SCN, CBMH Chase an Idea, SickKids Foundation, Rare Diseases Foundation, MS Scientific Foundation (Canada), McLaughlin Centre, Mario Battaglia Foundation. Juno, Scientific Advisory Board, Neurotoxicity. ACI, clinical relapse adjudication. Novartis, speaker´s honorarium. MOH IGSP reviewer. A. Oyefiade, S. Shams, A. Noguera, S.A. Grover, Dr. Wilbur, Dr. Wan, Dr. Costello, Dr. Reginald have nothing to disclose.